### IN THE COURT OF APP EALS OF TENNESS EE AT JAC KSON A pr il 18, 200 7 S es sio n CURTIS N. ROBINS ON, ET AL 

### . v. BA PT IST M EMORIAL H OSP ITAL - LAU DER

DA LE
A Dire ct A ppeal f

rom the Circ uit Court for Laud erdale County No. 5710 The Honorabl e Joe H. Walker, III, Judge

No. W2006-01404-C OA-R3-C V - F iled Augu st 15, 2007

Th is a pp e a l ari se s f

ro m a me di cal ne g lig e nc e c a se in w hic h a jur y ve rd ic t w a s e nte re d in favor of Plaintiffs/Appellees a nd ag ainst Defe ndant/Appellant Hospital. The H ospital ap peals on numerous g rounds including : ( 1) whether the trial court e rre d in allowing c erta in evidence in alleg ed contravention of Tenn. R. Civ. P. 26.05 and 37.03, (2) whe ther the tria l court erre d in not gr anting the Hospital’s motion for newtrial on the g rounds of a lleg ed inappr opriate a nd i n fl ammatory comments and a

rg uments by opposing counsel; and (3) whether there is material evide nce to support the jur y ’s ve rd ic t. F ind ingno e rr or , w e a ff ir m. Tenn. R. App . P . 3; Appeal as of Right; Judgme nt of th e Circ uit Court is Aff irm ed
W. F RAN K C RAW FORD , P.J ., W.S ., delivere d the opinion of the court, in which A L AN E. H I G H ERS , J . and H OL L Y M. K I RBY , J ., joined.
J ames L . Kirby

and Timothy

D. Patterson of Me mphis, Tennessee for Appe llant, Ba ptist Memorial Ho sp ita l- L a

ud e rd a le Charles M. Ag ee, Jr. of Dy ersbur g , Tenne ssee f o r Appellees, Curtis N. Robi nson and Shirley Robinson
OP IN ION Curtis N. R obinson (tog ether with his wife, Shi rley Robinson, the “Robinsons,” “Plaintiffs,” or “A ppellees” ) bec ame totally disabled and beg an drawing Social Security disability in 1990. Mr. Robinson suffers fr om numerous m edica l problems i ncluding : (1) diabetes, (2) sever e neur opathy (ner ve pain) , i n cl u d i ng a nea rly complete loss of fe eling in his legs a nd fee t, (3) dizz iness and balanc e proble ms, (4) toe, fee t, he el, and a nkle sores, blisters, de cubitus ulcers dating a s far back a s 1990, (5) vision problems, which r equire d three surg erie s t o h i s ri gh t ey e and a pproxi mately

five surg erie s to his left ey e, (6) osteomy letis (weakness in the bones) a nd sever e osteoporosis, (7) hear t pr ob le ms, inc lud inga t le a st thr e e he art a tta c ks

.-2-

On Fe bruar

y 11, 2002, Dr. Carl Huff admitted Mr. Robinson to Bap t i s t M em orial Hospital–L auder dale ( the “Hospital,” “De fenda nt,” or “ Appellant” ) t o p erf orm surg ery

for a fra cture d left hip. Dr. Huff discharg ed Mr. Robinson from the Hospital on Fe bruar y 25, 2002. Dr. Hu ff ’s dis c ha rg e or de rs ind ic a te that Mr . Ro bin so n’ s c on dit ion is “g oo d, ” that Mr . Ro bin so n s ho uld un de rg o o utp a tie nt p hy sic a l th e ra py , a nd that Mr . Ro bin son sh ould s e e Dr . H uf f f or fo llo w- up in approximately

four we eks Following his discharg e fr om the Hospital, Mr. Robinson did not follow Dr. Huf f’s orde rs to u nd e rg o p hy sic a l th e ra

py . Rathe r, Mr . Ro bin so n te st if ied that he sp e nt a

pp ro xima te ly

e ig hty perc ent (80%) of hi s post-operative time in his recliner a nd approximately

twenty perc ent (20%) of his tim e in bed. Mr. Robinson’s next scheduled a ppointment with Dr . Huff w as on Mar ch 15, 2002. Dr

. Hu ff ’s m ed i ca l re co rdfo r t h at v i s i ts t at es t h at “p at i en tre p o rt s d ec u b i t i o nb o t h h ee l s . ” A l t h o u gh Dr. Huf f testified that he first noticed the pr essure sores on Mr. Robinson’s he el s t h e day of discharg e fr om the Hospital, there a re no w ritten notes in the dischar g e su m m ar y conce rning Mr. Robinson’s heels. The f

irst notation concer

ning the ulcer s is that contained in the medical r ecor d of Mar ch 15, 2002. On or abou t April 5, 2002, Dr. Huf f dictate d a discha

rg e summary

for Mr. Rob ins on ’s ho sp ita l st ay , w hic h en de d on Fe br ua ry 25 , 200 2. I n his dic ta tio n, Dr . Huf f n ote s th a t, de sp ite no rm a l pr e c a

uti on s, Mr . Ro bin so n d e ve lop e d d e c ub iti wh ile in t he Ho sp ita l.
On or a bout March 12, 2002, Mr . Robinson saw his pr imary car e phy sician, Dr. Scr ivastava. Dr

. Sc ri va sta

va dia g no se d Mr

. Rob ins on wi th bil a te ra l de c ub itu s ulc e rs , wh ic h we re gangreno us . Dr

. S cr i v as t av a r ef

erre d M r. R o b i n s o nt o D r . R o y C h u a tt h e W o u n d C ar e C en t er

i nDy er s b u rg, Tenne ssee. Dr

. Chu te stified that the Wound Care Center de als with difficult wounds that a pr imary car e phy sician m ay not have the expertise or t he facility to treat as an outpatient. Dr. Chu testified that Mr. Robinson had develope d necr otic, infec ted ulcer s on the posterior a spects of both he els as a re su lt o f h is F e br

uary 20 02 Ho sp ita l st ay . D r. Chu tr e a te d M r. Rob ins on

wi th a n a nti bio tic to protec t him from sy stemic bac teria inva sion and schedule d him f or outpatient surg ery

to remove the dead tissue on Marc h 21, 2002. The follow- up car e re quired seve ral visits to the W ound Care Ce nter for a dditional surgic al debr idements of the de ad tissue, antibiotic thera py , and pain mana g ement.
I n J une 2002, Mr. Robinson suffe red a calc aneus f

rac ture of his rig ht heel. Dr . Huff tr eate d Mr. Ro b i nson for this injury . I n Dr. Huf f’s off ice note of

Dec ember

12, 2002, he re ports that Mr. Robinson’s ulcers ar e hea led; however, Dr . Huff c ould not testify as to the exact date that the wounds wer e hea led.
On J anuar

y 27 , 2 003, the Robinson filed their Complaint ag ainst the Hospital. The Com pla int re a ds , in pe rt ine nt p art , a s f

oll ow s: (5 ) Wh ile pla int if

f, Cur tis N. Rob ins on , wa s a

patie nt i n th e ho sp ita l, the ag ents, serva

nts a nd/or employ ees of

defe ndant...fa iled to provide the proper car e and treatment f or the plaintiff, and failed to fo l low p ro p er h o s pital policy

and protoc ol so as to reduc e or e liminate the ri sk of the pla int if

f h a vin g be d s or e s and c ir c ulatio n pro ble ms. As a-3- result of their f

ailure to prope rly

car e and pr ov i d e fo r t he plaintiff, Curtis N. Robins on, the pre ssure on his heels caused blis ters and later an infe ction, which almost turned into g ang rene . (6) As a result of the ne g lige nce of the serva

nts, ag ents and/or employ ees of

the def endant, plaintiff, Curtis N. Robinson, was re qu ir e d to un de rg o a dd iti on a l surg e ri e s o n h is f e e t a t th e Me tho dis t Hospital of Dy ersbur g on or about Mar ch 21, 2002, by Dr. Roy Chu and on or a

bout J une 20, 2002, and J une 27, 2002, by Dr. Car l Huff. (7 ) T he pla int if

fs a lle g e that the de fe nd ant w a s n e g lig e nt a nd its serva nts, ag ents and/or employ ees deviated from the standar d of ca re and skill ex pecte d and req u i re d of them in the same or simil ar community

and that it was this neg lige nce, w hich was the direc t and proxi mate re sult of the injuries and damag es ca used to the plaintiff.... Mr. Robinson sought $500,000.00 in damag es; Mrs. Robinson sought $100,000.00.
On Marc h 21, 2003, the Hospi tal filed i ts Answer , in which it denies the material alleg ations of the Complaint. On the same da y , the Ho s p i t al p ro p ounded Interrog atories a nd Requests for Production of Docume nts on the Robinsons. The Robins ons serve d their Answe rs to I nterrog atories and Reque sts for Production of Documents on the Hospi tal’s counsel on J uly 7, 2003. During the course of discover

y , the Robinsons identified Dr. Carl Huff as one of their expert witnesses a long with the fac ts and opinions to w h i ch h e would be ca lled to testify . The Hospital took Dr. H uff’ s deposition on April 18, 2005. Prior to the trial in this case, the H o s p i t al filed a Motion in L imine on Febr uary 10, 2006, s ee k i n g t o ex cl u d e c er t ai nt es t i m o n y , i n cl u d i n g:

Any testimony , evidenc e, questioning or argument from the plaintiffs and their w itnesses conc erningany deviation from the standard of car e or c oncer

ning the cause of any injuries to the plaintiff, other tha n the opinions previously

dis closed in the discove ry deposition of the pla int if f’ s e xpe rt wi tne sse s, Dr . Ca

rl Hu ff and Dr. Ro y

Chu . T his includes any

new opinions of Dr . Huff c oncer ning the cause o f t he pla int if f’ s c a lc ane us fr a c tur e , w hic h w ere not di sc los e d in his discovery deposition on April 15 , 2005 [si c], and any other ne w opinions that were f

ormed a fter his de position. Following arguments, the trial cour t denied the Hospital’s motion. The c ase w as tried to a jur y from F ebrua

ry 27, 2006 until March 1, 2006. The jury returne d a verdic t f

inding for Mr. Robinson in the amount of $300,000.00 and for Mrs. Robinson in theAs r equ i r ed by T en n . R. App. P. 3( e) , al l i s s u es r ai s ed i n t h i s appe al we r e s et ou t i n t h e ame n ded mot i on f or 1

n e w trial. -4- amount of $50,000.00. On Marc h 1, 2006, the trial court e ntere d a judg ment on the jury verdic t. On Marc h 30, 2006, the Hospital filed a Motion for New T rial or in the Alter native for a Remittitur. On April 7, 2006, the Robinsons filed their response . On May 25, 2006, the Hospital filed an Ame nded and Corre cted Motion for N ew Tr ial or, in the Alternative, for Remitti tur. On May 30, 2006, the 1 trial court e ntere d an Or der de ny ing the motion for new trial and denying the motion for re mitti tur. The Hospital appe als and ra ises three issues for re view as state d in its brief:

1. Whe the r t

he tr ia l c ourt

e rr e d in a llo wi ng P lain tif

f’ s e xpe rt to testify at trial as to new and chang ed opinions and fa cts that wer e not d i s c l o s e d i nd i s c o v e r

y. 2. Whether the trial c ourt err ed in over ruling Def

endant’ s Motion for New T rial whe n Plaintiffs’ counsel re peate dly m ade arguments and statements to the jury

that were pre

judicial, improper, a

nd not su pp or te d b y the e vid e nc e , a

nd wh ic h d e nie d D e fe nd ant a fa ir tr ia l. 3. Whether there is material evidenc e to suppor t the Plaintiffs’ theory at trial that the De fenda

nt was liable for corpor ate ne g lige nce or the amount of dama g es aw arde d.
Dr . Hu ff’s T e st im ony On a pp e a l, t he Ho sp ita l a sse rt s that the tr ia l c ourt e rr e d in de nyingits Mo tio n in

L imi ne to exclude any

portion of Dr. Huff’ s testimony that contained new and/or c hang ed opinions that were not disclosed during discovery

. Specifica lly , the Hospital alleg es three points of error in Dr. Huff

’s tr ia l te sti mony . F ir st, the Ho sp ita l a sse rt s th a t D r. Hu ff ’s te sti mony

c on c e rn ingthe a

pp lic a ble standard of

nursing car e and the possible deviation t here from is outside the s cope of his discovery deposition. Next, the Hospi tal asser ts that the t rial court should not have allowed D r. Huff to testify a b o u ts e e i n g M r . R o b i n s o n ’ s h e e l u l c e r s a tt h e t i m e b e f o r e h i s d i s c h ar g e f

r o m t h e H o s p i t a l

. F i n a l l y, the Hospital contends that Dr . Huff’ s trial testimony conce rning the ca

use of the June 2002 hee l fra cture should not have bee n allowed. As the basis for e rror , the Hospital asser ts that these portions of Dr. Huff’ s trial testimony are outside the s cope of his discovery

deposition The Hospital contends that it rece ived no notice of any chang e, or suppleme ntation, to the opinions espoused by Dr. Huf f in his deposition. Consequently , by allowing Dr. Huf

f to testify outside the scope of

his deposition, the Hospital asser

ts that the trial court allowed a violation of Tenn. R. Civ. P. 26.05 to go without sanc tio ns . T e nn . R. Civ . P. 26 .0 5 r e a ds , in re le va nt p art , a s f

oll ow s: A p art y wh o h a s r e sp on de d to a

re qu e st fo r d isc ov e ry

wi th a re sp on se that was c omplete when ma de is under no duty to supplem en t the-5- response to include information thereaf ter a cquire d, except as fo llo ws : (1 ) A p ar t y

i s u n d er a du t y s ea s o n ab l y

t o s u p p l em e n tt h e p ar t y 's response with respec t to any question directly

addre ssed to (A) the ide nti ty and loc a tio n o f p e rs on s h a vin g kn ow le dg e of dis c ov e ra

ble matters, and ( B) the identity of ea ch per son expected to be called as an e xpe rt wi tne ss at tr ia l, t

he su bje c t matte r o n w hic h th e pe rs on is e x p e c t e d t o t e s t i f y, an d t h e s u b s t an c e o f

t h a tt e s t i m o n y. (2) A party is under a duty seasona bly to amend a prior re sponse if the party obtains information upon the basis of wh i ch the party (A) knows that the re sponse was incorre ct when made, or (B ) knows that the re sponse thoug h corr ect wh en made is no long er true and the c ir c ums tanc e s are su c h th a t a fa ilure t o ame nd the re sp on se is i n su bs tanc e a kn ow ingc on c e a lme nt.
Te nn . R. Civ . P. 37 .0 3 s ta te s, in p e rt ine nt p art , th a t: A p ar ty who without substantial just ification fa ils to suppl ement or a me nd re sp on se s to dis c ov e ry

reques ts a s r e qu ir e d b y

Rul e 26 .0 5 is not permitted, unless such fa i l u re is har mless, to use as evidenc e at tr ia l, at a he ari ng , o r o n a

mot ion any wi tne ss o r i nf

or ma tio n n ot s o disclosed. I n addition to or in lieu of this sanction, the court on mot ion may imp os e oth e r a

pp ro pri ate sa

nc tio ns . In a dd iti on

to re qu ir ingpa

y me nt o f r e a so nab le e xpe ns e s ( inc lud inga tto rn e y fe e s) cause d by the failure , these sanctions may include any of the a ctions authorized under Rule 37.02( A), (B ), and (C) and may include informing the jury

of the fa ilure to supplement or amend.
I n the instant case , the Hospital contends that the por tions of Dr. Huff

’s testimony

discussed above should have be en excluded from the e vidence at trial under Tenn. R. Civ. P. 37.03 because the Robinsons allege dly

failed to c omply

with Tenn. R. Civ. P . 26.05. Under Tenn. R. C i v . P. 26.05(1), the Robinsons are r equire d to supplement Dr. Huf f’s re sp on se s o nly

a s to “ any

qu e sti on dir e c tly a dd

re sse d” a t the de po sit ion

. I f D r. Hu ff ’s ans we rs to any qu e sti on dir e c tly a dd re sse d at the de po sit ion have sig nif ic antl y c ha ng e d f ro m di sc ov e ry

to t ri a l, then we must dete rmine whe ther the chang e is substantial enoug h to warr ant furthe r disclosure unde r Tenn. R. Civ. P. 26.05. I f so, t hen we must deter mine whether such di sclosure or supplementation was made

. I f n ot, then we must deter mine whether

the trial cour

t erre d in not ex cluding the test im o n y f r o m t r ia l a n d /o r in n o t i mp o s in g s an c ti o n s a s a ll o w e d u n d e r T e n n . R. Ci v . P. 3 7

. 0 3. Be fore addre ssing these question, howeve r, we must also note that the trial court is af forde d wide discretion in the admission or re jection of e vidence , and the trial court' s action will be re verse d on-6-

appea l only

when ther e is a showingof an a buse of discr etion. Se eOt is v . Ca mbrid

ge Mut. Fir eIns. Co. , 8 50 S.W. 2d

43 9 ( Te nn .1 99 2) ; Da v is v . Ha ll , 920 S.W .2d 213, 217 (Tenn.Ct.App.1995). T he abuse of di s cr et i o n s t andar d require s us to consider: (1) w hether the dec ision has a suffic ient ev i d en tiary

foundation; (2) w hether the trial cour

t corre ctly

identified and pr operly

applied the a pp ro pr ia te le g a l pri nc ipl e s; a nd (3 ) w he the r t

he de c isi on

is w ith in t

he ra ng e of a c c e pta ble alternatives. State e

x rel. V aughn v. Kaatrude , 21 S.W .3d 244, 248 (Tenn.Ct.App.2000). Whi le we wi ll s e t a sid e a

dis c re tio na

ry de c isi on if it d oe s n ot r e st o n a

n a de qu a te e vid e nti ary

fo un datio n o r i f it is contrary

to the go v erninglaw, we will not subst itute our judg ment for that of the trial cour

t mere ly beca use we might have chosen a nother a lternative. Testimony

reg ardingthe standar d of ca re I n th e ir su pp le me nta l ans we r t o th e Ho sp ita l’ s fir st s e t of int e rr og a tor ie s, the Rob ins on s li st Dr . H uf f a s o ne of

the ir po te nti a l e xpe rt s a

nd divulg e d th e sc op e of

his te sti mony

a s f oll ow s: 2. Dr. Car l W. Huff
* * * Dr. Huf f is a boar d cer

tified orthopedic sur g eon. Dr. Huff w as the surg eon that admitted M r. Robinson to t he B aptist Memorial Hospital–L auder dale f

or a displac ed int ertroc hanter ic fra cture of the left hi p. Dr. Huff i s expected to testify that while Mr. Robinson was a patient at Ba

ptist Memorial Hospital–L auder dale f rom Fe bruar

y 11, 2002, thr[ough] Febr

uary 25, 2002, he deve loped l es i o ns cause d by prolong ed pre ssure due to the l ack of proper car e of the hospital staff a t Bap tis t Me mor ia l H os pit a l–L a ud e rd a le . F ur

the r, Dr . H uf

f i s e xpe c te d to te sti fy

a s to his tr e a tme nt o f M r. Rob ins on ’s he e ls. The Hospital, then, wa s put on notice that Dr. Huff would be ca lled as an e x pert to testify about the alleg ed “la ck of proper car e of the hospital staf f....” I n his discha

rg e summary (which w as dictate d on Ap ri l 5, 2002), Dr. Huf f states, int e r a lia , that “[i] n spite of all normal pre cautions, he [Mr. Robinson] did develop dec ubitus on both heels.” At the April 18, 2005 deposition, counsel for the Ho sp ita l qu e sti on e d Dr . Huf f co nc e rn ing his op ini on that th e nurs e s to ok “ no rm a l pr e c a

uti on s” in the ir c are of Mr . Ro bin so n, to w it: Q. So is it y our position that nor m al p re ca u tions were taken at the ho sp ita l?
A. Wel l, p e rh a

ps no rm a l pr e c a

uti on s, bu t f

or a patie nt o f t

his su sc e pti bil ity

may be it s ho uld

have be e n e xtra or din ary

pr e c a uti on s. * * *-7- Q. All rig ht. But y ou do ag ree that normal pre cautions we re taken–
A. I ag ree with– Q. –b y the ho sp ita l?
A

. –t h a t , ye s , s i r , I d o . I a g r e e w i t h t h a t

. A b s o l u t e l y. Q. What do y ou

c a ll e xtra or din ary

pr e c a uti on s?
A. Having some kind of protec tor over the heel that pr events c ontact of the he el with the bed or any other surf

ace . * * * Q. Do y ou ag ree that if normal pre cautions we re t aken, that the nurs e s c arr ie d o ut t

he nurs ingre sp on sib ili tie s th at nur se s o rd ina ri ly do?
A. Wel l, Ise e y our p oin t, a nd the re is c e rt a inl y

a va lid state me nt t o make. B ut Ig uess the thing about it, decubiti occur red, so that mea

ns there was pre ssure on the he els for a n extended period of time. So, it i sn’t–Imean, it happe ned. So by d ef i n ition there wa s too much pressure on his heels during the time he wa s there. Q. I s it y our b e lie f t

hat if an in jur y oc c ur s, tha

t th a t a uto ma tic a lly means that someo n e at the hospital deviated fr om the standard of prac tice that they

should have followe d?
A. I think that the presenc e of a heel d ec u b i tus by

definition is–means that there was a defic iency

of ca re. * * * Q. I f y ou’re g oing to testify that nurses de viated fr om the standard of prac tice that the nur ses should have f ollowed–and I ’m not sure you are since we ’ve ta lked about this norma l pr eca utions that they

took, but if y ou have a

ny criticisms of the nurse s, I ’d like for y ou to point that out to me in the medical re cord.-8- A. The only

criticism Ihave is that the decubiti or the pressure sores oc curr ed whi le he wa s in the ho sp ita l. T hat’ s th e on ly c ri tic ism I have.
* * * Q. I s the only

basi s fo r y o ur opinion that the nursing car e wa s somehow def

icient the fa ct that he develope d, at some point in ti me, de c ub itu s u lc e rs ?
A. Th a t’ s c or

re c t. * * * Q. Have y ou told me all the opinions that y ou have about the nursing c are and the ba sis fo r t

ho se op ini on s? A. Yes, sir. At the deposition, counsel for the Robinsons asked Dr. H uff t h e fo l l o wing , rele vant, questions reg ardingthe nursing car e:

Q. Okay . And y ou indicated that with 20/20 hindsight may be ther e sh ou ld h a ve be e n e xtra

pr e c a uti on s f or thi s p a tie nt, c or

re c t?
A. Rig ht. Q. B u tt h e s e w o u n d s

– d o t h e s e w o u n d s o c c u r w i t h o u t

– d o t he se wounds occ ur if the nur s es t h at are there 24/7, if they are aler t and pe rf or m th e ir du tie s to re lie ve pr e ssu

re on the are a of his he e ls? A. No, sir. Q. Th e y wo uld n’ t oc c ur , is that c or

re c t? A. No, sir. Q. So y o u believe that based upon a rea sonable de g ree of medica l cer tainty this was a deviation awa

y from the standa

rd of c are that y ou would expect nurses to provide [ ] proper nursing car e at the hospital i nt h i s

– i nt h e R i p l e y c o m m u n i t y?
M R

. KIRB Y: Ob

j ec t i o nt o t h e l ea d i n g.-9- A. (The witness) Ye s, sir.
At the tr ia l, D r. Hu ff

’s re le va nt t e sti mony

c on c e rn ingthe nurs ingc are wa s a s f oll ow s: Q.

.. .[F ]ro m th e tim e he [Mr . Ro bin so n] w a s a dmi tte d unti l th e tim e he wa s discharg ed on the 25 , do the nurses on a regular ba sis, or th should nurses o n a re g ular ba sis go into the patient’ s room and pr ov ide a sse ssm e nts and

pr ov ide nurs ingc are to t hat patie nt? A. Yes, sir. Q. All rig ht. Woul d that be the standard of nursing car e in the Ripley are a ba c k in F e br ua ry of 20 02 , to do that? A. Yes, sir. Q. And what sort of t hings would a nurse–let’s s ay on Fe bruar y 14 , th afte r he g ot moved to the swing bed, what sort of t h i n gs wo u l d a nurse–would you expect to see in the patient’s char t that a nurse w as d o i n g?
MR. KI RBY: Your

Honor, I have a n objection. THE COURT: All rig ht, sir.
MR. KI RBY: May

we a pproac h? THE COURT: Yes, sir. (A be nch conf

ere n ce was he ld on the rec ord, in the pre sence of the j u ry b u to u to f t h e h ea ri n g o f t h e j u ry an d t h e fo l l o wi n g p ro ce ed i n gs wer e had.)
MR. KI RBY: The y ’re g oing into new opinions that have neve r bee n disclosed. There has never been a disclosure that Dr. Huf f wa s g oing to testify about what nur ses sho u l d do on these e x aminations or e va luatio ns or

ho w o ft e n th e y

sh ou ld v isi t or

any su c h th inga s th a t.
Dr. Huff, in his deposition, sa id his only opinion was that the nursing car e wa s defic ient beca use there wer e hee l ulcers. He had no other ba sis f

o r any opinions. And now we’r e hea ring new-10- information

. An d Iasked in his deposition did he have any other opinions whatsoever

related to this case, a

nd he said none

. THE COURT: Mr. Ag ee. MR. AGEE: J udg e, I

think he’s–I

don’t think this i s any

kind of surprise. We’re not a sking him to g ive any differ ent opinion th an wh at he’ s alway s g iven. H e wa s n ever asked this question in his deposition. And, y o u know, for Mr . Kirby to make a shotgun question, Do y ou have a ny other opinions about this case, obv i o u s ly wouldn’t be addre ssing g ener al issues of medicine and what happens in a hospital s et t i n g. THE COURT: All rig ht. T h e o b j ec tion will be overruled to the question as aske d. The Court will allow him to respond.
* * * Q. Okay . Dr. Huff, j ust briefly , y ou testified t hat nurses in hospital se tti n g s , i n - p a t i e n tp o s t

- s u r g i c a l p a t i e n t s , n u r s e s c o m e i nt h e r oo ms an d p r o v i d e

– l o o k

a tt h e p a t i e n t

. W h atd o t h e y d o i nt h e r e , g e n e r a l l y?
A. Wel l, wh a t I un de rs tand a bo ut nurs ing c are is a care p lan is established, and the n they will follow throug h with that. Eac h patient has diffe rent ne eds, of c ourse. And t h en t hey will chart pe rtinent things that re flec t what they observe and what was done.
* * * Q. Okay . Now, Dr

. Hu ff , do y ou have a

n opinion based upon a rea sonable de g ree of medica l cer tainty whether it wa s nece ssary

for Mr. R obinson, a post operative patient, t o have been care d for by the nurs ing sta ff so a s to no t de ve lop any tr a uma to h is h e e l are a

or to h is fe e t? [O b je c ti o nb y

d e f e n s e c o u n s e l t o le a d in g

– o v e r r u le d ]. A. Well, in Mr. Robi nson’s ca se he sustained a dec ubitus ulceration of bot h heels, and this was caused by pressure on his heel fr om lay ing in bed without adequate re lief of this pressure a nd monitoring of the re su lts of thi s p re ssu

re . A nd he did su sta in t his ill e ff e c t f ro m hi s h o s p i t a l s t ay.-11- Q. Okay . Then, is it y our opinion, based on your re view of the rec ords and your examination of y our patient, that he develope d a condition that was in both heels wh i l e a patient at the hospital, that wa s c a us e d b y pr olo ng e d p re ssu

re on tho se he e ls? [O b je c ti o nb y

d e f e n s e c o u n s e l t o le a d in g

– o v e r r u le d ]. A. Yes, sir....
* * * Q. I s th er e any

doubt...that the medical c ondition y ou descr ibed as pr e ssu re so re s or de c ub itu s ulc e rs on bo th he e ls, is the re any do ub t in y our mind that they

wer e ca used fr om p ro l ong ed pre ssure while he wa s at th e ho sp ita l? A. That’s howit happened. Q. Oka y . A nd

do y ou have an o pin ion

ba se d u po n a re a so na ble deg ree of medica l cer

tainty whether or not that con dition can occ ur in a hospital setting a

bsent a de viation from t he standa rd of nur sing car e re quired in this are a?
A. I t couldn’t have happene d without that breac h.
I n compar ing the t es t i m o ny adduce d at Dr. H uff’ s deposition with that had at the trial, we cannot c onclude that Dr . Huff c hang ed his initial opini on or testimony reg arding either the standard of ca re r equire d in Mr. Robinson’s case, or the nursing car e that was a ctually rende red, to such a

n extent as to rise to the level of tria l b y s u rprise or ambush. Throug hout his testim ony Dr. Huf f maintains that the particula r hee l injuries with which Mr. Robinson p re s en t ed , could not have occur red but for the a

pplication of prolong ed pre ssure at those points (a fac t that Dr. Chu corr oborate s). Althoug h we c oncede that an injury , i n and of itself, is not, ipso facto, proof of neg lige nce (a lega l conclusion which the j ury was admonished not to rea ch), a close readingof Dr. Huff’ s testimony

reve als that his positi on, in both his depositi on and trial testimony , rema ined materia lly

unchang ed. The g rava men of Dr . Huff’ s testim o n y is that, give n Mr. Robinson’s particula r hea lth issues (i.e. neuropathy broug ht about by

sever e di ab et es ), so ca lled “norma l pr e c a ut i o n s ” t o r e l i e v e p r e s s u r e w e r e n o ts u f f i c i e n ti nt h i s c a s e . F u rt h e r m o r e , b e c a

u s e t he se particula r hee l ulcers that Mr. Robinson develope d wer e dire ctly cause d by

prolong ed pre ssure on that are a, the nurses, althoug h they provided norma l car e and pr eca utions in t his case, did not provide those protec tions reasona bly require d by

a patient with Mr. Robinson’s known phy sical condition (i.e. e x traordina

ry prec autions). Testimony

reg ardingwhen Dr . Huff f irst noticed the hee l injuries-12-

Turning to Dr. Huff

’s testimony

rega rd i n g wh en he f

irst noticed Mr. Robinson’s heel inj ur ie s, in his Ap ri l 18 , 2 00 5 d e po sit ion , D r. Hu ff te sti fi e s th a t he e xami ne d M r. Rob ins on ’s he e ls when he was admitted to the Hospital and that, at that time, the hee ls “wer e norma l.” Howe ver, at the time Mr. Robinson was discharg ed fr om the Hospital, Dr. Huf f testifies that he sa

w the beg inning sta g e s o f t he ulc e rs , to wi t: Q [to Dr. Huff]: All right. What do y ou reme mber s ee i n g o n Mr. Rob ins on ’s he e ls b e fo re he le ft the ho sp ita l? A. They wer e blac k. Q. Can y ou be more specific ? A. The a rea of skin over the heels wa s black. Q. Ther e ca

n be diffe rent shade s of black. H ow w o uld y ou c ha ra c te ri ze t he bla c kn e ss o f h is h e e ls?
A. Ver y black. Q. Okay . What siz e?
A. I ’d say thr e e c e nti me te rs a c ro ss. Q. Ok ay . Wa s th e sk in i nta c t?
A. Yes. Y es, i t was int act, and no draina g e or a ny thing. So, I

mean, y ou a lw ay s h op e tha

t.. .und e rn e a th m ay

be it’ s n ot f

ull thi c kn e ss l os s, may be it will be okay , may

be it will heal. You just have to wait and se e .. .h owit d e ve lop s. Pr og re sse s. Q. With t he skin intact y ou cannot c all it a decubitus u l ce r at t hat time, can you?
A. No y ou cannot. I t’s impending. It would be an impending decubitus. That’ s true. Q. What did y ou call it–or what did y ou consider it to be whe n y ou saw his hee ls on Febr

uary 25?
A. Pr e ssu

re so re s. Pr e ssu

re are a s. Fr om this t estimony , the Hospital was put on notice that Dr. Huff would likely testify at trial that D r. Hu ff

ha d n oti c e d the bla c k a

re a s o n M r. Rob ins on ’s he e ls o n F e br ua ry 25 , 2 00 2. At

tr ia l,-13-

Dr. Huf f m aintained his position t hat he notice d the hee l abra sions prior to discharg ing Mr . Robinson fr om t he Ho sp ita l; h ow e ve r, he a lso te sti fi e d that Mr . Ro bin so n a nd his wi fe ha d “ dr op pe d b y ” his office a day or t wo after Mr. Robi nson was re lease d from the Hospital to show Dr . Huff the black are as on Mr. Robinson’s hee ls. Dr. Huff rec alled that he told Mr. Robinson, both before he left the Hospital and whe n he and Mr s. Robinson dropped in at the offic e, to see Mr. Robinson’s primary car e phy sician. Althoug h not contained in the de position, Dr. Huff’ s added te stimony at trial that he ha d a lso se e n th e he e l inj ur ie s a da y or tw o a ft e r Mr

. Rob ins on ’s dis c ha rg e fr om t he Ho sp ita l di d not prejudice the Hospital’s ca se. The Hospital knew , or should have know n, from the inter rog atory response and from the deposition testimony , that Dr. Huf f would testify

(as he did) that the hee l injuries wer e appa

rent be fore Mr. R obinson left t he Hospit al on Fe bruar y25, 2002. Given this pretrial information, the Hospital wa s g iven notice th at i t s h o u l d be pre pare d to defe nd ag ainst the alleg ation that the heel ulcer s wer e prese nt at the end of Mr. Robinson’s Hospital stay . The fa ct that Dr. Huff t estified about the drop-in visit at t he office two to three day s after Fe bruar y 25, 2002 does not put a g reater burden on the Hospital’s case than Dr. Huff’ s testimony that he sawthe injuries on Fe bruar y 25, 2002. Testimony

reg ardingthe J une 2002 hee l frac ture Turning to the calc aneus f rac ture Mr. Robinson suffe red in June of 2002, Dr. Huf f testified that he w a s Mr . Ro bin so n’ s tr e a tin g ph y sic ian f or thi s in jur y . Co nc e rn ingthe inj ur y , in his de po sit ion

te sti mony , D r. Hu ff

te sti fi e s, in r e le va

nt p art , a s f

oll ow s: Q. You mentioned something about a c alca neus fr actur e? A. Yes, sir. Q. Ha d M r. Rob ins on

fr a c tur e d a

he e l? A. Yes, sir.
* * * Q. Ho w d id h e fr a c tur e that he e l?
A. He wa s w a lki ng on hi s dri ve wa y and too k a mis ste p, and

c a me do wn ha rd on his fo ot. Q

. W a s t h a tb e c a

u s e o f h i s n e u r o p a t h y?
A. We ll, Ife e l li ke tha

t he did n’ t ha ve no rm a l f

e e lin g , a nd wo uld have some bear ing on it, y es, sir.-14- Q. Have y ou seen a

ny note about him at one time wa lking on a hot pave me nt?
A

. I t h i n k

t h a t ’ s w h e ni th a

p p e n e d , a c tu a l l y? Q. Was he ba

re fo ot?
A. Ithi nk

he wa s. Q. He w as bare foot, and beca use of his ne uropathy he could not fee l the he a t, t hat it wa s b lis te ri nghis fe e t?
A. I ’m sure that he wo uld

no t ha ve be a ble to f e e l th e he a t. Q. I s his neuropathy

sever e? A. Yes, sir.
F oll ow ingthe de po sit ion , th e Rob ins on s’ a tto rn e y fo llo we d- up wi th Dr . Huf f re g ard ingthe po ssi ble causa l link betwee n the decubitus ulcer s and the calc aneus fra cture

. Dr. Huff sent a letter dated Ma y 17 , 2 00 5 to the Rob ins on s’ a tto rn e y . T he le tte r r e a ds , in pe rt ine nt p art , a s f

oll ow s: Iwo uld lik e to r e sp on d to y our q ue sti on re g ard in g the de c ub iti involving the he els of Mr. Curtis Robinson. He underwe nt a[n] open reduc tion and internal fixation of the left hip on 2/11/02 and during the cour se of his hospital stay he developed decubiti in both heels that require d extensive treatment and w er e o p en wounds for some time. He wa s treate d in the wound ca re c linic at Dy ersbur g . On 6/21/02 he was at home and twisted his rig ht heel ra t h er v i olently on or about 6/18/02. On the day

of admiss ion he simply took a step and the whole hee l are a opene d up like a book and there was a n obvious dis pla c e d f

ra c tur e a lon g the lon g itu din a l a xis of the c a lc ane us . T his was an open fra cture beca use the fra cture occur

red r ight throug h the are a of the decubitus which was alre ady open. The ref

ore the fra cture itse lf w o u ld o th e r

w is e h a v e b e e n a c lo s e d f r a c tu r e b u t d ue to the prese nce of

the dec ubitus it was ther efor e an o p en fr acture. The c a lc ane us wa s c on sid e re d to be we a ke ne d a s a re su lt o f t he de c ub itu s. Be cause of the de cubitus the patient wa s not as ambul at o ry as he would have be en and disuse oste oporosis of the ca lcane us would have wea kened the bone. In addition w h en there is an opene d are a the c ir c ulator y dy namic s w ill c ha

ng e and inc re a se the loc a l me ta

bo lis m which would tend to incr ease the t urnover of t he bone. As you know at the post erior heel the calc aneus is a subcutaneus bone that there areT he R o b i nsons’ at t o rney cl ai m s t hat he s ent a co p y of D r. H uf f ’ s l et t er, al o ng wi t h a co ver l et t er dated June 2 1 , 20 0 5 , t o t he H o spi t al ’ s at t o rney t hereb y noti ci ng t hem of D r. H uf f ’ s ad d i t i o nal , or supp l em ent al , op i ni o n t hat M r. R o b ins o n ’s h e e l fra c tur e w a s c a u sa lly link e d to the u lc e rs h e a lleg e d ly d e v e lo p e d in the H o sp ital. A ltho u g h D r. H u ff ’s le tter w a s a d m itt e d into e v id e n c e , see i n f ra , t h e J u n e 1 , 2 0 0 5 c o v e r le tter is no t a p a rt o f t h e re c o rd o n a p p e a l.

-15- no tissues betwee n the skin a nd the bone except for

the subcutane ous fat. T he a ss oci ation o f t

he c a lc ane a l f

ra c tur e wi th t

he de c ub itu s is indirectly implied by

the fa ct that the fra cture was exactly at the leve l of the de c ub itu s. Th e patie nt w a s n ot re a lly a ble to am bu la te wi th a ll the pr ote c tiv e br a c ing that he wo uld no rm a lly have uti lize d w e re it not for the dec ubitus. Theref ore if you look at all the fa ctors involved wer e it not for the d ec u b itus the patient very likely would not have su sta ine d th e inj ur

y and fr a c tur e to t

he c a lc ane us . 2 At the trial of this matter, in his direc t examinatio n , Dr

. Huff te stified, in releva nt part, as fo llo ws c on c e rn ing

the c a us e of the June 20 02 he e l f

ra c tur e , to wi t: Q. An d d o y ou

have an opin ion , Dr . Huf f, ba se d upo n a r e a so na

ble de g re e of me dic a l c e rt a int

y wh e the r o r n ot t

he he e l f ra c tur e would have oc curr ed had it not bee n for the de cubitus ulcer? A. Well, I think his [ Mr. Robinson’s] conditio n o f h i s b one wa s compromised from his pr olonge d inactivity , which weakens bo n e, plu s th e inf

e c tio n th e re , th e re mov a l of tis su e , a nd in crease i n circ ulation would tend to weake n the bone. Q. Ok ay . Wa s it

[the fr a c tur e ] als o at th e e xac t si te or wh e re his de c ub itu s u lc e r w a s?
A. Ye ah, the fr a c tur e , th e fr a c tur e lin e we nt r ig ht a c ro ss t he mid dle of the de c ub itu s. * * * Q. Then a g ain, just for clarity in the record, is it y our opinion based upon a rea sonable de g ree of medica l cer tainty that the fra cture to the heel c alca neus bone a

nd the medica l treatment nece ssitated by such an in jur y are a ll d ir e c tly

re la te d to the de c ub itu s u lc e r o n th a t he e l?
M R

. KIRB Y [ co u n s el fo r t h e H o s p i t al ] : Ob j ec t i o nt o l ea d i n g? THE COURT: The Court will allow the question.-16- A. Yes, sir.
On cr oss-examination, counsel for the H ospital questioned Dr. Huf f conc erningthe ca

use of the c a lc ane us fr a c tur e , in

re le va nt p art , a s f

oll ow s: Q. L et me hand you this lett er [ Dr. Huff’s May 17, 2005 letter, su pra ] Dr . H uf

f. B e fo re y ou loo k a t that, y ou wi ll r e me mbe r t

hat in y our deposition...when I asked y ou how he fra cture d his c al ca n eus bone in his heel a

nd y o u t o ld me about stepping down har d on the pave me nt. An d the n, a ft e r y our de po sit ion –d o y ou have the le tte r i n front of you? A. Yes, sir.
* * * Q. Well, y our letter of

May 17, 2 0 0 5 consi dera

bly chang ed y our op ini on a bo ut the c a

us e of the c a lc ane us fr a c tur e . Do y ou a g re e wi th that?
A. I don’t understa

nd what y ou mean. Q. We ll , le t m e b a c k

u p . I nth e v id e o c li p w e ’ v e n o w s e e ntw ice, when you wer e aske d, “How did he fra cture his heel? ” what ca used it?
A

. A g a i n , I w a s t r

yi n g t o r e c a l l f

r o m m e m o r

y. Q. I understand. A nd y ou told me that y ou jogg ed y our memory for the first time since y our deposition this morning , when you rea d y our d i s c h ar g e s u m m ar

y. A. I r e a d th e a c tu a l d o c u me n t w h e r e I h a d w r itte n w h a t ha d happene d.
* * * Q. B ut ever

y thing you said in c ourt today is in y our letter of Ma y 17, 2005, chang ing your opinion to try to– A. Well, where is my

–-17- Q. L et me finish–to try to c onnect the c alca neal f rac ture in the he el to t he so re s h e ha d o n h is h e e ls. F ir st t ime thi s sh ow e d u p, ri g ht?
A. Wh e r e d o y o u s e e t h a t I c h an g e d m y m i n d o r c h an g e d my op ini on ? Can y ou

sh owme that? Q. This is the first time it appear s where y ou say the ca lcane us was wea kened a s a re sult of the decubitus, refe rr i n g to the sores. And b eca use of the sor es, the patient was not as ambulator y and he g ot disuse osteoporosis of the c alca neus and a weakened bone. And y ou talk about the cir culatory dy namics, and y o u t ry

to relate it for the first time ever

to the heel sores. And y ou did that on May 17, 2005, a ft e r you we re c on ta c te d o n b e ha lf of the Pla int if

f, c or re c t? A. That doe sn’t– Q. Sir , am I

c or re c t?
A. This is supplemental information. I t doesn’t contra dict. I t’s ba c kg ro un d in fo rm a tio n th a t oc c ur re d le a ding up to t

his inc ide nt. This doesn’t re prese nt any kind of cha

ng ing of my mind or a diffe rent opinion.
* * * Q. Dr. H uff, let me g o back to my question. When Itook y our de po sit ion

and a sk e d y ou wh a t c a

us e d th e fr a c tur e of

the c a lc ane us , y ou on ly sa id w hat w a s in

the vid e o c lip , tha t he m iss te pp e d a nd c a me down har d on his heel. We’ve se en the video. We c an all ag ree what that sa id, ri g ht?
A. Rig ht. Q. All r ight. You said nothing about any connec tion b et we en the ca lc an e a l f

r a c tu r e an d th e s o r e s in y o u r d e p o s it io n w h e ny ou wer e asked w hat happe ned.
A. Wel l, i f I ha d be e n a sk e d the qu e sti on , I wo uld have sa id i t. A ll Iw a s a s k e d

w a s

– w e w e r e ta lk in g a

b o u t th e me c h an is m o f

in ju r y . We wer en’t talking about the pathophy siology that cre ated a

patholog ical fr a c tur e , w ithle ss t

ha n th e us ua l amou

nt o f t ra uma that it take s to fr a c tur e a c a lc ane us .-18- * * * Q. B ut after

y our deposition y ou felt compe lled to ge nerate a long answe r in this letter, trying to c onnect it, and that was after y ou wer e c on ta c te d b y

the Pla int if

fs ?
A. I ’m telling you, this was a p at h o l o gi cal frac ture. This wa s not y our o rd ina

ry c a lc ane a l f

ra c tur e . I ’v e ne ve r se e n a fr a c tur e lik e thi s– Q. Yes, sir.
* * *
M R. K I RB Y [c o u n s e l f

o r th e H o s p it a l] : A ll r ig h t. I ’ d li ke to mark that [Dr. Huff’ s May

17, 2005 letter] the next ex hibit, please. (Exhibi t No. 4, L etter dated 5/17/05, was marked an d admitted as evidenc e.)
On appea l, the Hospital asserts that the Robinsons’ attorne y failed to supplement Dr . Huff’ s deposition testimony

with his alleg edly

new opinions conc erningthe ca use of Mr. Robinson’s hee l fra cture . As noted above , see fn. 2, the Robinsons’ attorney asser ts that he sent a c opy

of Dr. H uff’ s letter to opposing counsel immediately afte r re ceipt of same. Given the fac t that the cove r letter f rom the Robinsons’ counsel is not part of the r ecor d on appea l (it is only contained in the a

ppendix to the Robinsons’ brief), w e ca

nnot know for c erta in whether , or whe n, the Hospital rec eived Dr . Huff’ s May 17 , 2 00 5 le tte r. As di scu sse d a bo ve , th e tr ia l c ourt

did no t g ra nt t he Ho sp ita l’ s Mo tio n in L imine, which containe d, int e r a lia , a re quest to exclude any testimony

by Dr. Huff “ conce rning the cause of t he plainti ff’ s calc aneus frac ture, which wer e not di sclosed in his discovery deposition....” Counsel for the Robinsons contends that t h e M o t ion in L imine was denie d, int e r a lia , beca use he sent a c opy

of Dr. H uff’ s letter to opposing counsel we ll in adv an ce of trial. The r ecor d contains only the Hospital’s Motion in L imine. There is no transcr ipt of the hear ing on the motion, nor is the Orde r g ranting same include d in the rec ord bef ore us. B eca

use our r eview is limited to the rec ord on a pp e a l, a nd in the a bs e nc e of the se do c ume nts , w e c ann ot c on c lud e that th e tr ia l c ourt a bu se d it s discretion in deny

ing the Motion in L imine. Reg ardle ss of the g rant or denial of the Hospital’s Motion in L imine, the rec ord bef ore us do e s n ot s up po rt

a fi nd ingthat th e tr ia l c ourt ’s a llo wi ngDr . H uf f’ s te sti mony

c on c e rn ingthe c a

us e of the heel fra cture rose to the leve l of reve rsible er ror. Dur ing D r. Huff

’s direc t examination, see su pr a , the Ro b in s o n s ’ a tt o r n e y f ir s t qu e s ti o n s D r . H u f

f a b o u t th e c a

u s e o f th e h e e l f

r a c tu r e . The Hospital contends that this line of questioning constitutes tr ial by ambush, and y et the only objection ra ise d is to l e a din g . T e nn . R. Ev id. 10 3 s ta te s, in r e le va nt p art , th a t:-19- Error may not be predicate d upon a ruling which a dmits or ex cludes evidenc e unless a substantial r ight of a par ty is affe cted, and (1) Objection . In c a se the ru lin g is on e a dmi tti ng e vid e nc e , a tim e ly objection or motion to strike appears of rec ord, st at ing th e spe c ific ground of

object ion if the specific g round was not a ppare nt from the context.... (B old ty pe adde d for e mphasis).
As dis c us se d a

bo ve , th e sp e c if

ic ob je c tio n to thi s p or

tio n o f D r. Hu ff

’s te stimo ny was to leading

. N o w , o na

p p e a l, th e H o s p it a l a s s e rts th a t t h e ir o b je c ti o nis to th e c o n te n t o f D r . H u f f ’s testimony as opposed to the f

orm of the que stion t h e R o b i n s ons’ attorne y used to elicit that information. The e videntiary rules re quire spec ificity

in obje cti ons so that the objecting party ’s conce rns may

be prope rly

addre ssed by the court. Be cause the only objection ra ised to this portion of Dr. Huff’ s testimony was to le ading , the trial court could not have r uled on the admissibility

of the evidenc e base d up o n a fa ilure to comply with Tenn. R. Civ. P . 26.05. Havingnot raised that specific objection at the tria l level, the Hospital ca nnot be hea

rd to complain on appe al.
I t is incumbent upon a party to take whateve r action is r easona bly available to pr eve n t or nullify the ha rm fu l ef

fe ct s o f an error

. Tenn. R. App. P. 36(a) . Wit h that in mind, even if we assume, arguendo (w hic h w e do no t) , th a t the tr ia l cou rt e rr e d in allo wi ng Dr . Huf f to t e sti fy

a s to the ca usal conne ction betwee n the ulcer s and the fr actur e, we n ote that Dr. H uff’ s May 17, 2005 le tte r, wh ich con tain s th e ve ry op ini on of wh ic h th e Ho sp ita l no w c omp la ins , w a s mo ve d in to evidenc e by

the Hospital’s own attorney

. Im proper Ar gum ents and S tate m ents by P laintif fs’ Coun sel The Hospital next asser

ts that its motion for new t rial shoul d have been gr anted based upon alleg edly improper c omments and arguments by the Robinsons’ c ounsel during voir dire a nd in the c los ingargume nt. B e fo re a dd re ssi ngthe sp eci fic state me nts ma de , w e fi rs t no te that, i n g e ne ra l, control over

the ar g ument of counse l resides with the trial c ou rt , and the tria l court has br oad discretion as to what shall and shall not be per mitted in arg ument. M

c Co ll um v . Hu f f stutter , No. M2 00 2- 00 05 1- CO A- R3- CV , 2 00 2 WL 31 24 70 77 , at *9 (T e nn . Ct. App . Oc t.8 , 200 2) . T he a pp e llate c ourt s g e ne ra lly

wi ll n ot i nte rf

e re wi th t he dis c re tio na

ry a c tio n of a tr ia l c ourt in re fu sin g to g ra nt a mistr ial or a

ne w tri a l f

or mis c on du c t of

c ouns e l in

argume nt u

nle ss t he argume nt i s c le a rl y unwar rante d and made purely

for the pur

pose of a ppealingto pas s i on, prejudice s and sentiment which cannot be remove d by sustaining the objection of opposin g counsel, see Perkins v. Sadler , 826 S.W .2d 439, 442 (Tenn. Ct. App.1991), or unless the appe llate cour t finds affir

matively that the arguments or statements af fec ted the re sult of the trial. See, e.g., P ullm an Co. v. Pennock , 118 Tenn. 565, 102 S.W. 73 (1907).
Vo ir Di re State me ntsIn o rder t o p l ace t he al l eged l y i nf l am m at o ry co m m ent s i n t hei r p rop er co nt ext , we have i ncl ud ed m o re of t he 3 tra n sc rip t o f t h e e v id e n c e tha n the A p p e llan t i n c lud e s in its b rie f. -20- On appe al, the Hospital cites thre e portions of the voir dir e, and a sserts that the line of questioning used by

the Robinsons’ attorney

was for the sole purpose of appe aling to the jury ’s sy mpathies and prejudices. The first alleg edly improper comment made by Plaintiffs’ counsel is as fo llo ws : 3
This is a civil c ase. Nobody is goingto jail, or nobody is goingto be e xec ute d, no bo dy

is g oin g to be take n aw ay fr om t he ir fa mil y or los e their j ob, no matter what y our dec ision is i n this case, whe ther it’s for the Pla int if

fs , my c lie nts , o r w he the r i t’ s f

or the De fe nd ant, B a

pti st Hospital....
I mmediately

following this statement, Plain t i ff s ’ co u nsel beg ins to question the jury on the applicable burden of

proof in the c ase. It is not unt il t wo p age s l ater in the transcr ipt that the Hospital’s attorney

objects. At the be nch conf ere nce, the Hospital’s attorney couche d his objection a s f oll ow s: M R

. KIRBY: The first thing , Ilet it go by , was he told them don’t

worr y a b o u t a ju d g me n t i nth is ; i t w o n ’ t a f f e c t a n y b o dy o r h u rt t he Def endant; nobody

will lose a job. I ’m objecting t o any more comments or ar g uments such as that....
F ro m hi s o wn

state me nt, c ouns e l f

or the Ho sp ita l di d n ot s pe c if ic a lly ob je c t to the Pla int if

fs ’ counsel’s c omments (set out above) , which they now cite a s err oneous; rathe r, De fenda nt’s counsel is objecting to “any

more c omments o r ar gu m en t s s uch as that.” The tria l court over ruled the ob jectio n a nd state d th a t it

“ wi ll a llo w [Pl a int if

f’ s c ou ns e l] to se e if

any jur or ha s a bia s a g a ins t returninga money

damag e.” E ven if we assume, arguendo , th a t the Ho sp ita l’ s o bje c tio n w a s ti me ly made a nd that it was sufficie ntly

specific , we nonetheless conclude t hat i t was not err or for the tr ial court to a ll o w Pl a in ti f

f s ’ a tt o r n e y to qu e s ti o nth e p o te n ti a l j u r o r s a b o u t a n y b ia s th e y mi g h t h a v e, which would make it difficult for them to awa rd dama g es in this case. When Plainti ffs’ c ounsel questioned the jurors about conce rns over insurance premiums, the tr ia l c ourt su sta ine d th e ob

je c tio n ma de by

the Ho sp ita l’ s atto rn e y , to wi t: MR. AGEE [counsel for the Robinsons] : O kay . I s there a ny body that wo uld be rel uc tant t o r e tur

n a fa ir awa rd to M r. Rob ins on

sim ply be c a us e the y wo uld be a fr a id t

ha t the ir he a lthins ur anc e pr e miums would g o up?
MR. KI RBY [counsel for the Hospital]: Objection.-21- THE COURT: Yes, sir. [Bench c onfer ence ]
MR. KI RB Y: Yo ur Ho no r, he ’s no w a sk ingthe m if the y are a fr a id t o return a n awa rd for the Plaintiff if t h ey think his health insurance premiums would g o up. The man is insu re d by Medica re a nd TennCar e. I t’s improper. Now, if I ’m g oing to be permitted to prove that th is m an in c ur s n o e xpe ns e s b e c a us e of his ins ur anc e , I ’l l do tha t. Mr. Ag ee is try

ing to do the opposite. THE COURT: Mr. Ag ee. MR. AGEE: J udg e, I ’d like to respond to that. I ’m not directing the question at all about whether or not this m an, my client, had insura

nce or not or is making a claim for reimbursement. I ’m simply asking the question to d et ermine if the y would be re luctant bec ause the y had e ith e r be e n tol d or wo uld su sp e c t that the ir ins ur anc e wo uld g o up if they returne d a ver dict. I f t h ey we re to consider that, they couldn’t g ive my client a f air ve rdict in this case.
* * *
THE COURT: Ididn’t know the hospital issued insurance

. MR. AGEE: Idon’t know if the hospital doe s. I ’m not talking a bout the ho sp ita l. I ’m ta lki ng a bo ut if the y wo uld thi nk g e ne ra lly that th e ir insurance rate s would g o up or the c ost of m edica l car e would g o up beca use there ’s a c laim. You see it on TV a ll the time.
THE COURT: You di dn’t ask about medical ca re. Y ou asked a

bout insurance

. A f t e r s u s t a i n i n g th i s o b

j e c t i o n , t h e t r i a l c o u rtm a d e t h e f o l l o w i n g s t a t e m e n tt o t h e j u r y: L adies a nd g entlemen, I

know that we’ re just g oing thr oug h the selec tion process at th i s t i m e, but the Court sustains the objection wi th r e g ard

to t he la st q ue sti on , a nd y ou do n’ t have to re sp on d to t hat.
Be cause the objection was sustained, the only thing the pote ntial jurors hea rd about rising insurance rate s was what was conta ined in Mr. Ag ee’ s initi al question, s up ra . L oo kin g a t th e ob je c tio na ble question in the context of the voir dire proce eding s, we cannot c onclude that the que stion asked by Mr . Ag e e pr e

jud ic e d eithe r the jur

y po ol, or the Ho sp ita l’ s ca se . I n fa c t, as the qu e sti on wa s lef t in-22-

the wake of the objec tion (without follow up or a cha nce to a nswer) , it m o re l i k el y could have prejudice d the Robinsons’ case if the jury pool otherwise would not ha ve thoug ht about potential rising insurance premiums based on a verdic t a g ainst the Hospital. At any rate , g iven the fa ct that t h e objec tion was sustained, and w ith the expl anator y lang uag e used by

the trial cour

t, we ca nnot conclude that this question alone rises to the leve l of reve rsible er ror. Following the g ranting of the Hospital’s objec tion to the previous question, Plainti ff’ s c ouns e l c on tin

ue d h is q ue sti on s a s f

oll ow s: MR. AG EE : O ka

y , I wi ll ask all o f you

a s a c oll e c tiv e bo dy , w ou ld any of y ou be a fr a id to or re luc tant to re nd e r a fa ir ve rd ic t, ev e n if i t me ant a hu g e pe rs on a l in

jur y mon e y dama g e awa

rd , sim ply be c a us e y ou wo uld be a fr a id y our me dic a l cos ts to y ou a t the ho sp ita l w ou ld g o up?
MR. KI RBY: Your

Honor, objec tion. THE COURT: The Court will allow that question.
Al tho ug h th e tr ia l c ourt

ov e rr ule d th e ob

je c tio n, he c a

uti on e d th e jur

y a s f oll ow s: L a die s and

g e ntl e me n, bas ica lly

wh a t w e ’r e tr

y ingto f ind ou t is if there is any

rea son y ou can’ t be a fair and i mpartial juror; if the pr oof sh ow s th e Pla int if

f i s e nti tle d to an aw ard , g ive an aw ard that is fa ir an d a d e qu a te ; if th e p r o o f s h o w s th e D e f e n d an t is e n ti tled to an awa rd , g ive an a

wa rd fo r t he De fe nd ant, a

nd he ’s tr y ingto f ind ou t if there ’s any

rea son y ou couldn’t g ive an adequate awa rd if, in fa ct, the proof shows it.... Closing Argument The Hospital also cites error with the P laintiffs’ closing arg ument. Specifica lly , the Hospital asser ts that the argument was outside the scope of Plaintiffs’ theory and the evidenc e adduced at the tr ia l. C on c e rn ingthe the or y of the c a se , Pl a int if

fs ’ c ouns e l ma de the fo llo wi ng , r e le va nt, state me nts i nh i s cl o s i n g: Th is c a se is, my fe e lin g , no t a bo ut ba d nurs e s. Th is cas e is about a c orporation, Baptist Memorial Ho s p i t al. That, if you reme mber Ms. B ohannon, she’ s very honest, and these ladies that ar e seate d in th e c o u rtr o o m t o d ay , a ll th e s e la d ie s ar e v e r y n ic e , v ery g oo d nur se s.-23- But these nurses we re pla ced in a n environ ment wher e they wer e re quired to perform a lot of work a nd do a lot of thing s for the co mp an y , y o ukn o w, an d s o m et i m es t h er e i s n o ten o u gh t i m e t o go around. A nd we’ re not sug g esting at all that the nurse s did any thing intentionally

to hurt Mr. Robinson o r wo u l d any patient or e ver would.
Nurs e s, it’ s a

ve ry ho no re d p ro fe ssi on . A s a mat ter of fa c t, this is m y brother- in-law, he ’s a nurse; my sister is a nurse, a nd I ’ve ha d a lot of fa mil y me mbe rs in the he a lth c are fi e ld. So I wa nt t o te ll y ou , f ir st o f a ll, thi s is no t a c a se a bo ut ba d nurs e s or ba d nurs ingin g ener al. This is a ca se, as I said, wher e ther e ar e just so many hours i na d ay an d j u s ts o m an y r o o m s yo uc ane n t e r i na d ay. * * *
You k n o w, i t ’s important for the hospital in thi s case . You know, I notice t h at t hey

sent these nur ses. These nurses a re he re. They have e noug h interest to be he re. They ’re not even na med par ties to t he laws uit

. I ’ve nev er s een o ne ad mi ni st rat or f rom Bapt is t H os pi tal in t

his courtroom dur ing the entire t hree day s of the trial. I t’s the administration that hires the nurse s; it’s the administ ra tion that provides enoug h nursing staffing for the patients in the hospital, and it’s the administration that de cides what cost containments [sic] they wa nt t o ma ke and ho w the y wa

nt t o tr e a t th e ir

patie nts . So I ’m

qu ite surprises that we don’t have any body from ad m i n istration at the ho sp ita l–f ro m th e ho sp ita l in

the c ourt ro om. On a pp e a l, t he Ho sp ita l c on te nd s th a t th e se state me nts c on sti tut e a new theo ry of the c a se (i.e. c orporate neg lige nce on the part of the Hospital) wh en t h e theory throug hout the trial was neg lige nce on the part of the nursing staff, w hich theory implicated the Hospital throug h the doctrine of respondeat superior

. We f irst note that counsel for the Hospital did not raise an objec tion after any of the a bove stateme nts. Howeve r, eve n if we a ssume, arguendo , th a t th e o b je c ti o n was prese rved f

or appe al, we none theless conc lude that this line of argum en t d i d n o t prejudice the Hospital’s ca se. F urthermor e, ther e is evidenc e in the rec ord to support this arg ument that the nurses we re ov e rw or

ke d at c e rt a in t ime s, to w it: Q [By Pla i n tiffs’ counse l to Kay Boha nnon, L .P.N. on duty

during some of Mr. Robi n s o n ’s hospital stay ]: All rig ht. Have the re be en times or–in Febr

uary of ‘02, wa s it–we re the re times whe n y ou had-24- a lot of people hollering at y ou and it was ha rd to g et eve ry

thing done?
A. That can happen any day , so it’s just as likely to ha ppen th en as i tw o u l d b e t o m o r r o w o r ye s t e r d ay. Q. Have y ou had as ma

n y as s i x teen pe ople hollering at y ou at one time, try ing to g et somethingdone? A. Oh, sure. Sure. Be cause y ou don’t just do for y our patients. You do fo r w ho ne e ds

. Q. Okay . So y ou may

have to do–is it then y o u m ay have to do so me thi ngfo r s ome bo dy

oth e r t ha n y our p a tie nt, c or

re c t?
A

. C e rt a i n l y. * * * Q. L e t me ask

y ou thi s: A re c e rt a in n

ur se s a ssi g ne d to c e rt a in patients during their stay

there ? A. Yes, sir. Q. Okay . That’s what Ithought. In ot h er words, y ou’re not responsible for

ever y room on that floor? A. Not totally

responsible, no, sir. Q. B ut s ome tim e s y ou ’re tak e n a wa y fr om your r oo m to he lp so me bo dy

wi th t he ir ro om, c or

re c t?
A

. E x a c t l y. Q. An d th a t w a s tr

ue in F e br

ua ry of ‘0 2, wa sn ’t

it?
A. Th a t’ s a lw ay s b e e n tr

ue , y e s. We n o te th a t n o o b

je c ti o n to th e li n e o f qu e s ti o n in g u s e d b y Pl a in ti f f s a t tr ia l w a s lo d g e d b y

the Hospital. Given the evidenc e adduce d at the trial, the arguments made by Plaintiffs’ counsel during argument are not outside the rec ord. While the crux of Plainti ffs’ c ase is their c ontention that the nursing staff did not t ake a dequate prec autions with Mr. Robinson given his par ticular medic al problems, the re ason why the nurses a lleg edly

did not properly

car e for Mr. R o b i n s o n i s not the-25-

g rava men of the case . Whether by plain neg lige nce on the part of the nurses, or ne g lige nce br oug ht about by under- staffingor disorg anizatio n wi t h i n t h e org anization, the bottom l ine is whether the car e g iven to this particular patient was ade quate. In fac t, by stating that “[t] his case...is not about bad nurse s,” the Plaintiffs risk doing more ha rm to their own ca se than to the De fenda nt’s. Having trave led at trial unde r the theor y that the nurses pr ovided inadequate ca re, a nd to only

hint at the Hospital’s administrative shortcoming s during that proce eding , the Plaintiffs’ de ci s i o n , at the c los ing , to state tha

t Mr

. Rob ins on ’s ou tc ome is no t a bo ut ba d nurs e s is, in t

he op ini on

of thi s Co ur t, to risk damag ing the ir ca se by instil ling too much sy

mpathy for the nur sing staf

f. The Hospital next asserts that, during his c losing, Plaintiffs’ attorney argued fac ts that were no t in e vid e nc e , to wi t You know, y ou hear d one of the nurses testify t h at she would have kn ow n it [i.e . th a t Mr . Ro bin so n ha d he e l ul c e rs ] be c a us e sh e wo uld have sme lled it or she would have felt it. Well, y ou know, if it was in the s t at e t hat it beca

me, that it prog resse d to on March 20 or 21, whe n Dr. Chu

a t th e Wound

Care Clin ic too k th os e ph oto g ra ph s. No w, to be tot a lly ho ne st, wh e n the se nurs e s g a ve the ir de po sit ion s, no bo dy e ve r sa id t

he y saw o r c he c ke d h is h e e ls. No w, a t so me tim e befor e this trial–
MR. KI RB Y: Yo ur

Ho no r, Iob

je c t. T he ir

de po sit ion s are no t in evidenc e. I t’s what the nur ses said fr om the witness stand.
M R

. A G E E : O k ay. THE COURT: All rig ht. The jury will have to c onsider the testimony hear d here in court. Any depositions that may have been r ead to the live witnesses were for purposes of y ou to determine w hether a prior inconsistent statement was made

.... Wit h the cur ative instruction, a nd in the context of the entire rec ord, we find that this portion of the Pla int if fs ’ a rgume nt d id n ot p re

jud ic e the jur

y to s uc h a n e xten t a s to wa

rr ant a ne w tri a l.
Th e Ho sp ita l als o ta

ke s is su e wi th c e rt a in s ta te me nts ma de by Pla int if fs ’ c ouns e l du

ri nghis re bu tta l argume nt, to w it:

Iwant to talk abo u t the contra dictions in thi s case . You know, one contra diction Mr. Kirby

forg ot to tell y ou ab o u t was Dr . Katz [ the Hospital’s ex p er t ]. Dr. Katz contradicte d ever y treating doc tor that l ai d h ands on Mr. Robinson from the da y he deve loped his ulcers until he was re lease d.-26- Now, y ou know, y ou decide what weight to give Dr . Katz and Dr . Chu. .. and

Dr . H uf f. B ut I su g g e st t o y ou th at wh a t’ s st ra ng e to me is that they

[t he Hospital] have to g o d o wn t o J ackson, Mis sis si pp i. Yo u k

no w, B a pti st H os pit a l is he a dq ua rt e re d in Memphis, Tennesse e, and th ey’r e a ver y pow erful, very able, fi nanciall y strong com pany w ith – MR. KI RBY: Your

Honor, I object. That’s inappropriate. THE COURT: All rig ht. The objec tion–
MR. AGEE: Iwill withdraw the fina ncial, Judge. THE COURT: All rig ht, sir. Please. MR. AGEE: They

are a compa

ny , and–
MR. KI RBY: Well, Ialso object beca use this hospital here in Ripl ey is its own non-profit self, and it’s not–it’s a se parate, independe nt corpor ation. THE COURT: All rig ht, sir. (Emphasis adde d). Whil e we conce de t

h a t M r . A g e e ’ s s ta

te me nt conce rning the financ ial streng th of the Hospital sh ou ld n ot h a ve be e n a llo we d ( wh ic h it wa s n ot) , w e do no t fi nd that the state me nt w a s ma de pure ly for the pur

pose of a ppealingto passion, prejudice s and sentiment of the jury

. See Perkins v. Sadler , 826 S.W .2d 439, 442 (Tenn. Ct. App.1991). T ak en in context, it appears that, with this line of argume nt, Mr . A g e e wa s r e ite ratin g his tr ia l po sit ion tha t a Ho sp ital as la

rg e a s B a pti st, wi th i ts c or po rate he a dq

ua rt e rs in a c ity a s la rg e a s Me mph is, ha d to g o to Jac ks on , MS to fi nd an e xpe rt to support its position. Even if the arg ument was inflammatory , we find that any harm wa s removed by the withdrawa l of

the question and the subse quent statements made by Mr. Kirby . Fur

thermore , when the t ri al court charg ed the jury , he re minded them that they “must not be influence d by any persona l likes or dislikes or any persona l prejudice or any persona l sy mpathy

. You m ust decide the case solely

on the evidenc e bef

ore you and accor ding to the law.” The jury was a lso cautioned that the ar g uments of counsel are not proof. Fr om the t otality of the c ircumstance s, we c annot conc lude that these stateme nts, when viewe d in their context and in light of the entire rec ord, rise to the le vel of re versible e rror . Suf fi ciency of the evidence and am ount of dam ages awarded On appe al, the Hospital asserts that the j ury ’s verdict should be vacated beca use t here is no-27-

materia l evidence to suppor t the verdic t. Our revie w of the judgme nt e ntere d on the jury ' s verdict is g ov e rn e d b y

Te nn . R. Ap p. P. 1 3( d) , w hic h p ro vid e s th a t “ [f]in din g s o f f a c t by a jur y in c ivi l a c tio ns sh a ll b e se t a sid e on ly if the re is n o mate ri a l e vid e nc e to s up po rt the ve rd ic t.” Un de r t

his standard of

revie w, we “ are not at liberty to weig h the evidenc e or to decide where the preponde ranc e lies, but are limited to deter mining whe t h er t h er e is materia l evidence to support the verdic t.” Crabtree Masonry Co. v. C & R Const r. , Inc. , 5 75 S.W. 2d

4, 5 ( Te nn .1 97 8) . In ma kin g thi s deter mination, we ar e “re quired to ta ke the strong est leg itimate vie w of all the evidenc e in favor of the ve rd ic t, t o a ssume the tr uth of a ll that te nd s to su

pp or t it , all ow ing a ll re a so na

ble inf e re nc e s to sustain the verdic t, and to discard a ll to the contrary .” Id . I f the re cord c ontai n s an y materia l evidenc e to support the verdic t, we must aff irm the trial cour

t's judg ment. See id. ; ac c ord Forrester v . St oc ks til l , 8 69 S.W. 2d

32 8, 32 9 ( Te nn .1 99 4) . F ur the rm or e , w he n th e re so lut ion of the iss ue s in a ca se depe nds upon the truthfulness of witnesses, the trier of fac t who has the opportunity to observe the witnesses in their manne r and demeanor while testifying is in a f ar be tter position than this C ourt to decide those issues. Se eMc Cal e b v . Sa turn Cor

p ., 91 0 S. W.2 d 4 12 , 4 15 (T e nn .1 99 5) ; Whit aker v. Whitaker , 9 57 S.W. 2d

83 4, 83 7 ( Te nn .Ct .App .1 99 7)

. Th e we ig ht, fa ith , and c re dit to be g ive n to any witness' s testimony

lies in the first instance w ith the trier of f act, a nd t h e cr ed i b ility

acc orded will be g iven gre at weig ht by the appe llate cour

t. See id. ; se eals o W

alt on v . Young , 950 S.W .2d 956, 959 (Tenn.1997)

. Th e Ho sp ita l c on te nd s that, “ Pla int if fs a dv anc e d the the or

y thr ou g ho ut the tr ia l th a t th e c a se was not about nursingneg lige nce but a bout the hospital failing to hire a suff icient number of

nurses to improve its financial standing ....” As discussed above , in the examination of Nurse B ohannon the P l ai n t i ff s ad d u ce d t es t i m o n y fr o m wh i ch a re as o n ab l e j u ry co u l d co n cl u d e t h at t h er e wa s n o ten o u gh nursing staff dur ing the period of time at i ssue. Howeve r, during the course of the proc eeding s (and in their argument, su

pra ), Plaintiffs use this infor mation to infer that the nursing s t af f w as ov e rw or ke d a nd , th e re fo re , no t a va ila

ble to pr ov ide the ne c e ssa ry c are that Mr . Ro bin so n, wi th h is medical issues, re quired. How ever , based on the evidenc e bef ore us, we cannot c onclude that the Pla int if fs a sse rt e d a

the or y that th e Hos pi tal fa ile d to hir e su ff ic ie nt n umb e r o f n

ur se s in or de r t o im p r o v e it s e lf

f in an c ia ll y . Wh a t i s in

e v id e n c e is th e te s ti mo n y o f D r . H u f f an d th e deposition testimony of Dr. Chu. B oth of these doctors opine that Mr. Robinson’s hee l injuries would not, and should not, have occ urre d had he r ece ived the leve l of care r equire d for a patient in his phy sical state. Even Dr . Katz, the Hospital’s own expert, testified that, althoug h some dec ubiti are not pre ventable, “to g et bilatera l decubiti or bilatera l pr essure ulcer s in a heel in a patient who other wise is mobile, like this guy

was, I would think that that would not be–that would not be g ood car e....” Although the nurses a ll testified that Mr. Robinson did not have pressure sores on his heel when he left the Hospital, the medic al records kept by the nurses contain no notes c oncer ning a ny preve ntative measur es take n to avoid heel pressure . Fur thermore , their testimony

is rebutted by

Dr. Hu ff ’s te sti mony

that he saw the he e l in

jur ie s p ri or

to d isc ha rg ingMr . Ro bin so n f

ro m th e Ho sp ita l. Fr om our revie w of the entire rec ord, we conclude that there was material evidence on which the jury could have based its dec ision.-28-

Turning to the awa

rd rende red in this ca se, the Hospital asse rts that the $300,000 awa rded to Mr. Robinson and the $50,000 awa rded to Mrs. Robinson is not “within the rang e of rea sonablene ss.” We disag ree . I n Thrailki ll v. Patterson , 8 7 9 S

. W

. 2 d 836 (Tenn. 1994) , our Supreme Court re cog nized that, in cer tain case s, “it is the j ury ' s specia l province to evaluate damag es and that a life cannot be define d with ‘ mathematica l prec ision’.” Id . at 843. The Thrail kil l Court fu rt he r s ta te d th a t:

I n Wo lf ev . V aug hn , 1 7 7 T e n n . 6 7 8 , 6 8 8 , 1 5 2 S. W. 2 d 6 3 1 , 6 35 (1941), this Court stated t h at t h e “a mount fix ed by

the jury and c on c ur re d in by the tri a l ju dg e wi ll b e a c c e pte d u po n a pp e a l un le ss there is s o me th in g to s h o w a v io la ti o no f th e d is c r e ti o n ” o f

th e tr ial j u d ge. W e h av e a l s o s ai d t h at a ju ry v er d i ct t h at h as t h e t ri al j u d ge's approva l is e n titled to “gr eat we ight,” D.M. Rose & Co. v. Snyder , 185 Tenn. 49 9 , 525, 206 S.W .2d 897, 908 (1947), a nd that the appellate court “rar ely

ever ” disapprove s damag es set in this manner. Mc Cla rd v . Re id , 190 Tenn. 337, 343, 229 S.W.2d 505, 507 (1950). We a gain e mph a size d th e re sp on sib ili ty of the tr ia l ju dg e in deter mining whe ther the a

mount fix ed by

a jury is ex cessive: Af

ter he ha s a pp ro ve d th e ve rd ic t it

is ou r du ty

no t to dis tur

b it un le ss i t is e vid e nt t hat he fa ile d to ke e p th e jur y wi thi n r e a so na

ble bo un ds

. Thrail kil l , 879 S.W .2d at 840.
Her e, the pr oof conc erningdamag es is larg ely undisputed in the rec ord. Mr. Robinson and his wi fe te sti fi e d that, de sp ite a my ri a d of ph y sic a l pr ob le ms that e xiste d pr ior to t he he e l ul c e ratio ns , Mr . Ro bin so n c ou ld pe rf

or m od d job s, that he e njo y e d p lay ingwi th h is g ra nd c hil dr e n, and

wa s a ble to do y ard w ork. Prior to deve loping the de cubitus ulcers, Mr. Robinson testi fied that his enjoy ment of life wa s about seventy

perc ent (70%) ; after the i njuries, he testified that his enjoy ment of life ha d dropped to thirty

perc ent (30%) . Mrs. Robin s o n co rr o b orate d her husba nd’s testimony

when she testified that, prior to the pr oblems with his heels, Mr. Robinson was a “busy and indepe ndent man,” but since the injuries, she ha s to “wa it on him hand and foot.” The rec ord conta ins material evide nce t h at M r. R o b i n s o ns u ff

er edp ai n fu l i n

j u ri es wi t h p er m an en tef fe ct

. H e wa s re qu i re d

t o u n d er go p a in f u l, an d p r o lo n g e d , tr e a tm e n t in c lu d in g n u me r o u s d e b r id e me n ts o f th e n e c r o ti c ti s s u e . The evidenc e shows that, althoug h the wounds ultimately heale d, the re quired de bridements ca used pe rm ane nt l os s o f M r. Rob ins on ’s he e l pa ds

. Th e e vid e nc e sh ow s that, be c a us e of his inj ur ie s, it i s now nec essar

y for Mr. Robinson to wea

r brac es and corr ective shoe s in order to avoid further injury to his fee t. Ba sed upon the evidence before us, we find that the j ury ’s verdict is full and somewhat g ener ous but w ithin the rang e of rea sonablene ss g iven the nature and extent of Mr. R o b i nson’s inj ur ie s and

the lif e sty le c ha ng e s st e mmi ngthe re fr om. For the fore g oing r easons, we aff irm the judg ment of the trial c ourt enter ed u pon the jury v e r d ic t in th is c a s e . Co s ts o f th is a p p e a l ar e a s s e s s e d a g a in s t th e A p p e ll an t, B a p ti s t Memorial Hospital of L auder dale County , and its surety

.-29- __________________________________________ W. F R A N K C R A WF O R D , P R E S I DI NG JUDG E, W.S.